Thyroid Problems in Women and Children: Self-Help and Treatment

Introduction

I empathize with people who have thyroid problems because they have cropped up in my family, too. The very first thing I did when I became a doctor was to take my mother to see a thyroid specialist. My mother had an unsightly bulge in the front of her neck—easily cured, although she’d had it for as long as I could remember. Much later my daughter, a brilliant student, started slowing down and not coping well. By that time I had developed an interest in the thyroid, and we were able to nip the problem in the bud.

Thyroid disease affects an estimated thirteen to fourteen million Americans, and as many as one-half to two-thirds of those affected don’t even know they have the problem. Depending on the specific thyroid condition, five to ten times as many women as men suffer from thyroid disorders. (See the end of Chapter 1 for more about the prevalence of thyroid disorders in the United States.) Thyroid illness in American children is fairly rare (only about one in four thousand are born with thyroid underactivity, for example). However, thyroid problems that occur in newborns are critical and must be addressed within a few months of birth; if they are not, mental retardation or even death can be the dire consequences. Thyroid problems that occur in older children can easily go unnoticed; awareness and education on the parents’ part is crucial for detecting them.

That’s where this book can help. Thyroid Problems in Women and Children: Self-Help and Treatment outlines in detail the warning signs of thyroid disease in women and youngsters of all ages and offers suggestions for what to do when one or more of those signs is detected. Fortunately, treatment of most thyroid illnesses, in both adults and children, is relatively simple and enjoys a high success rate, as you will also learn from reading this book.

It may have been quite a shock to you when your doctor suggested doing thyroid tests. Perhaps you had gone to see him hoping he would prescribe something to buck you up because you were feeling so down—tired, sluggish, cold all the time, and, to add to your discomfort, constipated. Everything seemed to take twice as long and require twice the effort, and all this had crept up on you so sneakily. These symptoms are unpleasant, to be sure, but if the test results came back as underactive thyroid, take heart—you are actually in luck. An underactive thyroid is a common disorder. It can affect you at any age, but it is rather more likely to occur as you get older. The treatment consists of taking tiny white tablets to supplement your own supply of thyroid hormones. They work like magic, and they have no side effects. You will feel yourself gradually coming back to life again—and shedding those few unwanted pounds in the process.

On the other hand, you may have gone to the doctor wanting help with something quite different—your nerves. You may have started feeling anxious all the time, for no reason. You couldn’t sit still, you’d fly off the handle at the slightest thing, and your heart kept thumping. Although your appetite was enormous, you were losing weight, and that was a worry. These are the signs of an overactive thyroid. Sometimes the symptoms seem to come on after a shock, but usually no one knows why, out of the blue, the thyroid gland has started overworking. Fortunately, there is a range of medicines that will calm it down, and your mind and your heart will follow suit. Your body will run at its normal, peaceful pace again.

Or perhaps you’ve noticed a prominent bulge in the front of your neck, indicating a swelling of the thyroid gland. This condition is unimportant in itself from the health point of view. In some cases, for instance during pregnancy, it can be normal and temporary. In others it is due to either an overactive or an underactive thyroid, and shrinks down as the problem is settled.

It may, however, be your child you are worried about—he or she isn’t growing as quickly as other children, or is shooting up faster than they are. Either way, he or she is not doing well in school. Again, the remedy is straightforward.

As noted, thyroid problems affect women significantly more often than men or children, and my impression is that those affected are usually particularly warm, sympathetic people. Sometimes a thyroid malfuntion comes to light from some apparently unrelated symptom, such as heavy, irregular menstrual periods, or a near cessation of menstruation; fertility difficulties; problems in swallowing; or, in some older people, high blood pressure and certain heart conditions. These conditions, too, all respond to treatment that returns the thyroid to good working order.

What does it mean once a thyroid disorder has been diagnosed? Particularly if your thyroid is overactive, when the disorder itself makes you nervous, you may be worried about what the treatment entails. Nearly always, it only amounts to swallowing tablets. Sometimes this is for a short course, but in the case of an underactive thyroid it may be indefinitely. None of the treatments work immediately, but after two weeks, as a rule, you should experience an end to the worst discomfort. After that it is mainly a matter of fine-tuning the dosage. With an overactive thyroid, different medicines may be needed at different stages of recovery.

You may have heard of radioactive iodine as a treatment for an overactive thyroid. It sounds quite frightening, but it has been used for many years and is so safe that it is now recommended even for children. All that is needed for a permanent cure is to take radioactive iodine (in tablet or liquid form) once, and then wait. The treatment introduces very little radioactivity to the body as a whole, but a great deal to the thyroid. The radioactivity lasts only a few hours, but the beneficial effect comes on gradually, over several months.

As was the case in my family, thyroid problems, but not necessarily the same kind, often run in families. This is because they are mostly caused by autoimmunity—the body’s making a mistake and reacting against itself. Since thyroid disorders are 90 percent curable, don’t worry if they crop up among your relatives. If they do, and if you’re diligent about providing your doctor with a good family medical history, then he or she will be alert to thyroid problems in you, even if all you exhibit are the less straightforward symptoms.

While you are preoccupied with digesting the news of a thyroid disorder, you won’t be able to take in every word your doctor says, especially if she slips into using medical jargon. In Thyroid Problems in Women and Children I aim to share with you all the information you are ever likely to need about the thyroid, in understandable language and right up-to-date. After the opening chapter explains the physiological importance of your thyroid, the following three chapters are each devoted to a common thyroid disorder (enlarged thyroid, underactive thyroid, and overactive thyroid). Next, several chapters address thyroid problems in some of the critical life stages in women and children (pregnancy and birth, infancy, childhood and adolescence, and the senior years). Chapter 9 focuses on issues related to calcitonin—the other thyroid hormone.

The book’s final two chapters—on keeping your thyroid happy and on common thyroid tests and treatments—can be viewed as overviews or digests of information that in some cases is also discussed in earlier chapters. The difference is that in these two chapters the information is located all together in one place and is organized in convenient reference format.

I hope reading this book gives you the confidence to ask questions and get the best out of your discussions with your doctor. Most of all, I hope it helps you to avoid the sort of worrying that comes from not knowing what the disorder and its treatment involve.

Postscript: My mother had no further trouble with her thyroid and lived until she was ninety-five, and my daughter has enjoyed sparkling health for years.

Chapter 1

What Your Thyroid Does

for You

What is so special about your thyroid? In fact, it could not have a more important role. It is in charge of running every part of your body, including how you feel emotionally. As you can imagine, if it goes wrong you are affected all over, whatever your age, sex, or race. Yet it is a seemingly insignificant slip of tissue, weighing about an ounce (30 grams). It fits so neatly into the space around the lower part of your voice box—your larynx—that you wouldn’t know it was there unless you knew how to find it.

To locate your thyroid, look in a mirror and swallow. You will see your larynx move up and down at the front of your neck. Lean your head forward and feel each side of your larynx with your fingers and thumb. You can just detect a little bit of soft tissue closely attached to the sides of the larynx, making them feel less hard than the front part. This is your thyroid. Its name dates from the seventeenth century and comes from the Greek word for shield—after the shape of a Minoan battle shield.

The thyroid controls the body by producing hormones. The word hormone comes from the Greek word for stimulator, which is exactly what the thyroid hormones are. These chemical messengers boost activity all over the body. They travel in the bloodstream. Since every single part of the body must have its nourishment supplied through the blood for survival, it follows that hormones are also conveyed to every body part. The thyroid is small, but it is so busy and important that it has a wonderfully generous blood supply. Five times its own weight of blood goes through the gland every minute.

Not every organ or tissue needs a particular hormone in the same amount all the time, so a system is in place that is rather like leaving a note out for the milkman. The parts that require more hormones open up more receptors, which latch on to the hormones. Fewer receptors are opened up when less hormone is required. Thus, the right quantity is supplied to the right place at the right time.

The next several sections describe the various mechanisms through which the thyroid and its hormones influence your health and everyday functioning.

METABOLISM

The essential work of the body is called metabolism, from the Greek word for change. Metabolism involves taking in adequate amounts of food and processing it to provide energy to keep the heart, breathing, and digestion going; to fuel the muscles as and when needed; and to keep the brain running. It involves repair and replacement of tissues on a regular schedule, and the disposal of waste. Another metabolic task is the conversion of alcohol and medicines into a form in which the body can get rid of them. Imagine the chaos that would ensue if every cocktail or every aspirin you swallowed remained unprocessed in your body.

One of the thyroid’s most important jobs is to monitor and control your metabolic rate—the rate at which your body uses its fuel reserves. If there are heavy calls on your fuel reserves from your muscles because you are playing tennis or doing a spring cleaning, or from your digestive system because there is a big meal waiting to be dealt with, your metabolic rate accelerates. The orders for an increase in metabolism come via the thyroid.

Incidentally, a meal that is high in protein is hard work to digest; it therefore stimulates the metabolic reaction much more than a fatty meal. That is why weight-loss diets used to feature steak prominently, in the hope of inducing the metabolism to burn away unwanted flesh faster. The Russian diet, except for that eaten by the wealthy, contains a lot of oil and hardly any meat. This encourages the bulky figures we used to see in Red Square on television.

Several factors affect the metabolic rate; the remainder of this section describes some of them.

Basal Metabolic Rate

If you are doing nothing more energetic than, say, reading this book, your bodily functions will be just ticking along. In such circumstances, your metabolic rate will sink to its basic minimum—the basal metabolic rate, or BMR—under the guidance of the thyroid. The BMR remains high throughout childhood, when the body is undergoing active growth and making new tissues, and in pregnancy, another building period. It also stays high during breast-feeding. Thyroid hormone is particularly involved in the manufacture of body protein, especially muscle tissue, either your own or an unborn baby’s, or for milk production. The BMR settles down in ordinary adult life and middle age, but it decreases once you enter the contemplative phase of old age.

Geographical Climate

If you move to a colder climate, your BMR will rev up by as much as 50 percent after a few weeks, again under the direction of the thyroid. This happens because you have to burn bodily fuel faster to produce more warmth. Such vital internal organs as the liver and kidneys cannot work properly unless they maintain a normal temperature, regardless of the temperature of the hands and feet. People who live in the Arctic regions run at a consistently higher BMR, by 15 to 20 percent, than those of us in, say, London or New York. A small adjustment in the metabolic rate occurs between winter and summer even in temperate climates, and you will notice the instinct to take in bigger supplies of food in a cold snap. (A special tissue called brown fat is especially useful for producing heat. It is concentrated along the back. Babies, and to a lesser extent young men, have plenty of this material. The fat of the middle-aged has no such useful, warming function, but remains inert, padding the figure.)

If you live at or travel to high altitudes, the thyroid increases metabolic activity due to the reduced concentration of oxygen in the atmosphere. Serious mountaineers must acclimatize themselves before tackling the highest peaks. Exposure to long sunlit days also stimulates extra thyroid-hormone production and increased metabolism, although hot weather has the opposite effect.

Eating and Appetite

Another useful maneuver of the thyroid is the adjustment of both basic and short-term rates of metabolism in response to how much a person eats, though it doesn’t respond to actual body weight. If you persistently take in more food than your body needs, the thyroid will help to dispose of the surplus by having it burn up more rapidly. This automatically makes you feel warmer, whatever the temperature. You can see this mechanism in action next time you go to a restaurant. You are sure to spot one or two hearty eaters looking hot and flushed; they are burning fuel fast.

By contrast, if you are on short rations—whether by choice because you are dieting or because the food is unavailable—your thyroid will eke out the body’s needed sustenance from the available food supply by slowing down the metabolism. This is what happens in anorexia nervosa. A low metabolic rate makes a person feel deadly cold, and if it continues for long her health suffers.

Appetite is influenced by the thyroid, which nudges it toward what the body really needs. Since you are a free agent, you can, of course, override this sensible guidance. If you have been off your food because of a cold or an upset stomach, as you recover you find yourself craving simple, easy-to-digest, nourishing foods until you are back to normal. Often the thyroid dampens the appetite during the working week to compensate for a little indulgence on the weekend.

Unfortunately, the influence of the thyroid on appetite and metabolic rate depends not on how fat or thin you are, but on whether you are taking in more—or less—than you can use, particularly in comparison with what you have previously eaten. An overweight person who is trying to lose weight by eating very little will have a slow metabolic rate, so that he or she is burning the food reserves only very slowly—the reverse of what is wanted. At the same time, to make matters worse, the appetite will be pressing for more!

You may have noticed that men in general have bigger appetites than women. This is because they have a